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Thrush

Topic Overview

What is thrush?

Thrush is a yeast infection that
causes white patches in the mouth and on the tongue. Thrush is most common in
babies and older adults, but it can occur at any age. Thrush in babies is usually not
serious.

What causes thrush?

You get
thrush when a yeast called Candida, normally found on the body, grows out of control.

In babies, Candida causes thrush because
babies'
immune systems are not yet strong enough to control
the growth of the yeast. Older people get thrush because their immune systems
can weaken with age.

Some people get thrush when they take certain
medicines, such as
antibiotics or
inhaled corticosteroids. People who have certain health
problems, such as
diabetes or
HIV, are also more likely to get thrush.

What are the symptoms?

The most common symptoms of
thrush are white patches that stick to the inside of the mouth and tongue.

In babies, it is easy to mistake
thrush for milk or formula. It looks like cottage cheese or milk curds. Don't
try to wipe away these patches, because you can make them red and sore. Some
babies with thrush can be cranky and do not want to eat.

Talk to your doctor if you think you or your child has thrush.

How is thrush diagnosed?

In most cases, doctors
can diagnose thrush just by looking at the white patches. Your doctor will also
ask you questions about your health. If your doctor thinks that another health
problem, such as
diabetes, may be related to your thrush, you may also be
tested for that condition.

How is it treated?

Thrush is usually treated with prescribed antifungal medicine such as nystatin liquid.
In most cases, you will put the medicine directly on the white patches. When a
baby has thrush, the yeast can cause a diaper rash at the same time as thrush.
Your doctor may prescribe nystatin cream or ointment for his or her diaper
area.

To treat thrush in adults, at first you will probably use
medicine that goes directly on the white patches, such as a liquid or a
lozenge. If these medicines don't work, your doctor may prescribe an antifungal
pill.

How can you manage thrush?

If your baby has
thrush, it may help to:

Clean bottle nipples, pacifiers, toys, and other items that your baby may put in his or her mouth. Boil the items or wash them in warm, soapy water.

Dry your nipples and apply
lanolin lotion after breast-feeding. Your doctor may also prescribe a medicine that you can put on your nipples. Breast-feeding mothers and babies can
pass a yeast infection back and forth. So both mom and baby need treatment.

If you wear dentures and have thrush, be sure to clean
your mouth and dentures every night. You can soak them overnight in a denture
cleaner that you buy at the store. Rinse your dentures well after soaking
them.

Cause

Candida, the yeast that causes
thrush, is normally present in small amounts in the
mouth and on other
mucous membranes. It usually causes no harm. But when
conditions are present that let the yeast grow uncontrolled, the yeast invades
surrounding tissues and becomes an infection.

Thrush is most
commonly caused by the yeast Candida albicans. Less
frequently, other forms of Candida can lead to thrush.

There are many types of bacteria in your mouth that normally control the
growth of Candida. Sometimes a new type of bacteria gets
into your mouth and disrupts the balance of the organisms already there,
allowing Candida to overgrow. Health conditions and
other things may also be involved.

How thrush spreads

The
yeast that causes thrush can pass from one person to another in different
ways.

A newborn can get thrush during birth,
especially if his or her mother had a vaginal yeast infection during labor and
delivery. Newborns
and infants have an immature immune system and have not fully developed a
healthy balance of bacteria and yeast in their mouths. Because of this, thrush
is common during the first few months of life.

In otherwise healthy
toddlers and older children, thrush is usually not contagious. But a child with
a weakened immune system may get thrush by sharing toys or
pacifiers with a child who has the infection. A child who has thrush spreads the
thrush yeast onto anything the child puts in his or her mouth. Another child
may then get thrush by putting a contaminated object into his or her
mouth.

Adults who wear false teeth (dentures) are at a higher risk
for getting thrush and spreading it to others. A person can get thrush by
spreading the yeast from their hands to their dentures. And a person with
dentures may spread the yeast by handling their dentures and then contaminating
an object that another person touches or puts into his or her mouth.

Symptoms

Thrush can be a
mild infection that causes no symptoms. If symptoms develop, they may include
the following.

In infants

Symptoms of thrush in an infant may
include:

White patches inside the mouth and on
the tongue that look like cottage cheese or milk curds. Thrush is often
mistaken for milk or formula. The patches stick to the mouth and tongue and
cannot be easily wiped away. When rubbed, the patches may bleed.

A
sore mouth and tongue and/or difficulty swallowing.

Poor appetite.
The infant may refuse to eat, which can be mistaken for lack of hunger or poor
milk supply. If the infant is unable to eat because of a sore mouth or throat,
he or she may act fussy.

Diaper rash, which may develop because the
yeast that causes thrush also will be in the baby's stool.

In adults

Symptoms of thrush in an adult may
include:

A burning feeling in the mouth and throat (at
the start of a thrush infection).

White patches that stick to the
mouth and tongue. The tissue around the patches may be red, raw, and painful.
If rubbed (during tooth brushing, for example), the patches and the tissue of
the mouth may bleed easily.

A bad taste in the mouth or difficulty
tasting foods. Some adults say they feel like they have cotton in their
mouth.

A breast-feeding mother may get a yeast infection of her
nipples if her baby has thrush. This can cause sore, red nipples. She may also
have a severe burning pain in the nipples during and after breast-feeding.

What Happens

Most cases of
thrush are mild and clear up with the use of an
antifungal mouth rinse or lozenges. Very mild cases of thrush may clear up
without medical treatment. It usually takes about 14 days of treatment with an
oral antifungal medicine to cure more severe thrush infections. In some cases,
thrush may last several weeks even with treatment.

If thrush goes
untreated and does not go away by itself, it can spread to other parts of the
body.

Thrush can spread to the throat (esophagus),
the vagina, or the skin. It rarely spreads to other organs of the
body.

Infants can get a diaper rash because the yeast that
causes thrush is in the infant's stool.

Children who put
objects contaminated with the thrush-causing yeast into their mouths.

Complications

Complications related to thrush are
rare in healthy people but may include:

Poor nutrition for infants who have trouble
eating because of thrush.

Infection of the throat.

What Increases Your Risk

There are several things
that can increase your risk for getting
thrush.

Age

Newborns and infants don't have fully
developed
immune systems, which increases their risk of
developing infections, including thrush.

Newborns are also in the
process of developing a healthy balance of bacteria and fungi in their mouths.
If this balance is upset, the child may develop thrush.

Older
adults, especially those who have serious health problems, are more likely to
develop thrush, because their immune systems are likely to be weaker.

Behavior

The yeast that causes thrush can be spread by
oral sex.

Heavy smoking can lower the body's ability to fight off
infections, making thrush more likely to develop.

Other conditions

False teeth (dentures), braces, or a retainer
that irritates the mouth make it hard to keep the mouth clean and can increase
your risk for thrush. An unclean mouth is more likely to develop
thrush than is a clean mouth.

People with a
weakened immune system, such as those who have
diabetes or
human immunodeficiency virus (HIV) or who are having
chemotherapy treatments, have an increased risk for thrush.

Having a dry mouth (xerostomia) can lead to
thrush. Dry mouth can result from overuse of mouthwashes or from certain
conditions such as
Sjögren's syndrome.

Pregnancy increases
your risk for thrush. Hormone changes during pregnancy can lead to thrush by changing the balance of bacteria in the mouth.

Medicines

Medicines that can cause thrush
yeast to grow uncontrolled include:

Antibiotics, especially those that kill a
wide range of organisms (broad-spectrum antibiotics), such as
tetracycline.

Environment

Exposure over time to certain
environmental chemicals, such as benzene and some pesticides, can weaken the body's
immune system, increasing your risk for infections, including
thrush.

When To Call a Doctor

If you think you may have
thrush but it has not been diagnosed, see the topic
Mouth Problems, Noninjury to evaluate your
symptoms.

Call your doctor today if you or your child has been
diagnosed with thrush and:

You have symptoms that show the infection may
be spreading, such as white patches on the skin outside of the
mouth.

Your symptoms are getting worse or have not improved within
7 days of starting treatment.

Thrush in an infant's mouth can spread to the breast of the
nursing mother. This can cause nipple redness and pain. Contact your doctor if
you have redness and pain in the nipples in spite of home treatment or if you
have burning pain in the nipple area when you nurse. Your doctor will likely examine your baby's mouth to find out whether thrush is causing your symptoms.

Watchful waiting

If you have previously been diagnosed with
thrush and you believe you may have another thrush
infection, home treatment may help. Very mild cases of thrush may clear up
without medical treatment. Talk to your doctor if:

Your symptoms are getting worse or are not
improving in spite of home treatment.

Your symptoms recur
frequently.

You have
HIV infection, cancer, or another condition that
weakens your
immune system.

Exams and Tests

A visual exam is
usually all that is needed to diagnose thrush. In addition to looking in your
mouth, your doctor will ask you questions about your
medical history.

In rare cases, your
doctor may order a
KOH test in which one of the white patches is scraped and examined. A
KOH test is used only in cases when thrush is not clearly evident by
visual exam.

A fungal culture may be done when a diagnosed case of thrush is not responding to
prescribed medicines.

Treatment Overview

Thrush is a
yeast infection that can develop in the mouth and throat and on the tongue.
Thrush is most common in newborns, infants, and older adults, but it can occur
at any age. In healthy newborns and infants, thrush is usually not a serious
problem and is easily treated and cured.

Except for the mildest
cases, you should treat
thrush to keep the infection from spreading.
Prescribed antifungal medicines, which slow down the growth of yeast, are the standard
treatment for thrush. Thrush is most commonly treated with medicines that are
either applied directly to the affected area (topical) or swallowed
(oral).

Mild thrush

In adults, mild cases of thrush may
clear up with simple treatment that can be done at home. This treatment usually
involves using an antifungal mouth rinse or lozenges. Treatment usually lasts
about 14 days.

Mild thrush in infants is usually treated with
topical medicines until at least 48 hours after the symptoms have gone
away.

Moderate to severe thrush

More severe thrush
infections that have spread to the esophagus are treated with an oral
antifungal medicine. A topical antifungal medicine may also be used.

For some severe infections, a treatment period longer than 14 days may be
needed.

Persistent or recurrent thrush

Persistent or
recurrent cases of thrush may:

Need to be treated twice as long as the
symptoms last.

Require treatment with both oral and topical
antifungal medicines.

People with
weakened immune systems may need to take an antifungal
medicine on a continuous basis to prevent thrush infections.

It is
very important to get rid of any sources of infection, or thrush will continue
to come back. Boil toys, pacifiers, bottles, and other items a
child may put in his or her mouth. Or wash the items in warm, soapy water.

It is
important to treat conditions that make you more likely to get thrush, such as
diabetes, human immunodeficiency virus (HIV), or cancer. For more information, see Prevention.

Prevention

To prevent
thrush:

Practice good oral hygiene, including brushing your teeth twice a
day and flossing once a day. If you have had a
previous thrush infection, replace your toothbrush to help prevent another
infection. If you wear dentures, soak them each night in a chlorhexidine
solution that you can get from your pharmacist. You can also use a
denture cleaner that is sold in most drug or
grocery stores. Scrub your dentures with water both before and after soaking
them.

If you are taking a liquid antibiotic, rinse
your mouth with water shortly after taking it. If your child is taking a liquid antibiotic, rinse his or her mouth with water after each dose too. Antibiotics can disrupt the balance of bacteria in
the mouth and can allow the growth of the yeast that causes thrush.

Get treatment for
conditions that increase your risk for thrush, such as
diabetes, human immunodeficiency virus (HIV), or cancer.

Treat vaginal yeast infections, especially
during the last 3 months of pregnancy. This will decrease your baby's risk of
getting thrush during delivery.

Wash bottle nipples and pacifiers daily. And keep
all prepared bottles and nipples in the refrigerator to decrease the likelihood
of yeast growth.

Do not reuse a bottle more than an hour after the
baby has drunk from it, because yeast may have had time to grow on the nipple.

Wash or boil all objects that the baby puts in his or her
mouth, or run them through the dishwasher.

Change your baby's
diaper soon after it is wet. A wet diaper area provides a good environment for
the yeast that causes thrush to grow.

Breast-feed your baby if
possible. Breast milk contains
antibodies that will help build your baby's natural
defense system (immune system) so he or she can resist
infection.

Contact your doctor if you are breast-feeding and your
nipples become red and sore or you have breast pain during or after nursing
your baby. This may be a sign of a thrush infection in your baby that has
spread to your nipples.

If your baby needs medicine to treat
thrush, don't put the medicine dropper in the baby's mouth. Drop the medicine
on a cotton swab and swab it on the affected area. Throw away the swab, and
don't put anything back into the medicine bottle that could be contaminated
with the yeast.

Home Treatment

Babies and breast-feeding moms

If your child has mild
thrush, you may only need to clean bottle nipples and
pacifiers regularly and massage the inside of your child's mouth with a clean
moist cloth.

If you breast-feed, dry your
nipples after breast-feeding. And apply lanolin lotion, which may help relieve
nipple soreness. Your doctor may also prescribe a medicine that you can put on your nipples.

Adults and children (but not newborns)

Drink cold liquids, such as water or iced
tea, or eat flavored ice treats or frozen juices.

Eat foods that
are easy to swallow such as gelatin, ice cream, or custard.

If the
patches are painful, try drinking from a straw.

Rinse your mouth
several times a day with a warm saltwater rinse. You can make the saltwater
mixture with 1 tsp (5 g) of salt in 8 fl oz (240 mL) of warm water.

Gentian violet (1%) sometimes works as treatment for thrush. It is a dye that kills
bacteria and fungi, and it is available
without a prescription. Talk to
your doctor before using gentian violet.

Adults who wear dentures

If you develop thrush and have false teeth
(dentures), it is important to clean your mouth and dentures every night.

Remove your dentures before going to
bed.

Scrub them well with a clean toothbrush and
water.

Soak them overnight in chlorhexidine, which you
can get from a pharmacist. Or you can use a denture cleaner, which you can get from most drug or grocery stores.

Rinse
the dentures well in the morning. If you used chlorhexidine to soak
your dentures, don't use fluoride toothpaste for at least 30 minutes after
putting your dentures back in your mouth. (Fluoride can weaken the effect of
chlorhexidine.)

Medications

Prescription medicines that inhibit the growth of yeast (antifungals) are
used to treat thrush.

Antifungal medicines are either applied directly to the
affected area (topical) so the medicine affects only that area, or swallowed
(oral) so the medicine affects the entire body. In rare cases, an antifungal medicine will need to be
injected into a vein (intravenous, or IV).

Topical antifungal medicines

Topical antifungal
medicines are applied to the affected area and are available in several forms, such as rinses and lozenges.

Topical antifungal medicines
need to be in contact with the affected area long enough to stop the growth of
the yeast. Lozenges are preferred because they take longer to dissolve. Because
the lozenges need moisture to dissolve, sipping water while using them may
help them work better.

Because several of the topical
antifungal medicines contain sugar, there is an increased risk of
cavities when the medicines are used for long periods
of time. Using a topical fluoride rinse or gel (if you are not already
obtaining fluoride through other means) during treatment may help prevent
cavities. Talk to your doctor or dentist before you give your child fluoride products. Too much fluoride may be toxic and can stain a child's teeth.

Oral antifungal medicines (pills)

Unlike topical
antifungal medicines, oral antifungal medicines affect the whole body. Your doctor may prescribe a pill if you have a thrush infection in your esophagus. Your doctor may suggest that you use a topical antifungal medicine along with it.

Oral antifungal medicines are used to prevent thrush
in certain people with conditions that weaken the body's
immune system.

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